| Klumpke's paralysis | Erb's palsy |
| ------------------------------------------------------------------------------------ | ----------- |
| C8 / T1 lesion | |
| Claw hand due to unopposed action of long flexors and extensors | |
| Can have associated Horner's Xn (C8,T1 are in close proximity to sympathetic chain). | |
| Damage to one can cause damage to the other. | |
| Seen in breech delivery. (upward traction on arm) | |
| Loss of function of lubricals and wrist flexors | |
| Lumbricals flex the MCP joints and extend the PIP and DIP joints; | |
| In KP, there is | |

Causes of diabetes insipidus

Central	Nephrogenic
Intracranial SOL / pituitary surgery / trauma etc	Lithium
Infiltrative diseases: Histiocytosis, Sarcoidosis, (but ?not amy_loidosis)	⬆Ca, ⬇K
Haemochromatosis	Demecloclycline
DIDMOAD (ada Wolfram Syndrome)	Inherited: Common- ADH receptor mutation Rare: aquaporin 2 mutation

• Right side to right side. Left to left.
• fibers from superior half travel superiorly (parietal lobe) , fibers from inferior half travel inferiorly (temporal lobe)
  Lateral views showing the optic radiations:
  

[!INFO] Relevant cerebral lobes
Mnemonic: PITS ->

• Parietal lobe lesions -> inferior visual loss
• Temporal lobe lesions -> superior visual loss.

• Retrolenticular - inferior visual quadrants - In the parietal lobe
• sublenticular - superior visual quadrants - In the Temporal lobe.

Characteristic	EDH-epidural/ extradural	SDH-subdural
Patient	Young, Hx of trauma	Old
Aetiology	Usually trauma, spontaneous is very rare	Commonest is traumatic, cerebral atrophy (old age, chronic alcohol use) is a major risk factor
	-	Tamponade effect will control rate of bleeding (as it’s venous)
Type of bleed	80% arterial, therefore rapid	Mostly venous / small arteries
Site	Commonly middle meningeal artery at [[foramen spinosum.png]]	Bridging vein or other sites
Plane	Potential space between dura and skull	Between dura and arachnoid
Presentation	Lucid interval → rapid decrease	Can be acute or chronic.
Imaging	Lens shaped, does not cross suture lines, crosses dural attachments	Crescent shaped, crosses suture lines, does not cross dural attachments
	-	Chronic changes occur: Encapsulation and resorption / hygroma formation
	Also seen in trauma	most common type seen in trauma
	Lower impact, lucid interval present	Caused by Higher energy impacts - patient won't regain consciousness
	brief, linear contact force to the skull.	Can Occur in less severe trauma (antigoagulants, old age are RF)
	Arterial or venous. (commonest site = middle meningeal artery); caused by disruption of vessels secondary to dura separating from skull.	Mechanism: tearing of veins due to relative movement of brain due to acceleration
	rare in age > 60 as 'dura is tightly adherent to the skull'	highest incidence in 40s to 70s.
	most are acute.	Can be acute or chronic
Source

OR
Wernicke = Word Salad. (W - W)

• Neglect syndromes - parietal lobe involvement
  • More commonly affects right sided lesions. (commonest cause is a stroke).

[!TIP] Mnemonic: The parietal lobe is responsible for interpretation of "things in space";
Symbols lose meaning - agraphia, acalculia, alexia,
Disorientation
Spatial structure of tactile stimuli is lost - "cortical sensory loss"
Astereognosis

8. simultagnosis (inability to identify things in context - i.e can see trees but can't recognize Forrest)
9. Hemispatial neglect

Temporal lobe dysfunction

[!TIP] Mnemonic:
The temporal lobe seems to be involved in

1. processing and interpretation of sensory stimuli
2. predominantly auditory, also visual, smell etc.
3. Emotional regulation
4. Memory

Functions:

1. Processing sensory stimuli - Mainly sound ( but also vision, smell etc)
2. Memory - Hippocampus. (hippocampus is involved in making long term, emotionally connected memories)
3. Language comprehension
4. Understanding social cues
5. Facial recognition
6. Emotional regulation -> possibly due to involvement of the amygdala which is located in the medial temporal lobe.
   1. fear is a predominant emotion seen in temporal lobe problems.
7. Attention
8. Reward processing and motivation.

Features of temporal lobe dysfunction:

• Difficulty recognizing faces : prosopagnosia
• Visual agnosia - inability to identify objects.

Causes of QT prolongation:

4. Amiodarone is the drug of choice for for treatment of haemodynamically unstable VT.
5. Verapamil should never be used in VT - ?why
   F

The classic description of the left cardiac ventricle is as containing two papillary muscles: the anterolateral and posteromedial.[2] The anterolateral arises from the sternocostal wall, and the posteromedial papillary muscle arises from the diaphragmatic wall of the ventricle. The right ventricle contains three papillary muscles, classically described as anterior, posterior, and septal. Source

Left anterolateral papillary muscles derives from branches of the left coronary artery. The blood supply to the left posteromedial papillary muscles most commonly derives from the right coronary artery Source

[!INFO] Azithromycin
used as last resort add on therapy
Reduces exacerbation frequency but promotes antibiotic resistance.

Pulmonary arterial hypertension

• Pulmonary pressure ≥ 25mmHg. (UpToDate = 20mmHg)
• WHO recognized 5 groups based on aetiology
  • Group 1 - Pulmonary arterial hypertension
    • Subdivided into IPAH - idiopathic PAH
    • Heritable (HPAH)
  • Group 2 - Left heart disease
  • Group 3 - chronic lung disease / hypoxaemia
  • Group 4 - pulmonary artery obstruction
  • Gropu 5 - unknown aetiology

Pathologic findings in pulmonary arterial hypertension:

• hyperplasia and hypertrophy of all three layers of the vascular wall (intima, media, adventitia) in pulmonary arteries <50 microns (ie, localizes to the small pulmonary muscular arterioles).

Treatment:
Two groups:

• Acute vasodilator testing - positive response (the minority of patients) -> Treatment is calcium channel blockers.
• Acute vasodilator testing - negative response (the VAST majority of patients) -> Sildenafil, endothelin receptor antagonist (bosentan)
  • Endothelin is a vasocontrictor.